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Definition + Etiology
Microfractures in normam bone caused by overuse and repetitive actions. Can be caused by redistributing of impact force through a focal oint of bone, or by the pull of MM on a bone.
- High physical fitness
- Hard training surface, poor shoe choice
- Excessive pronation, mid/forefoot hypomobility or rigid cavus arch
- + amenorrheeic women
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CIs and Precautions
- NSAIDs =bad for bone healing
- Frictions/extreme hydro if inflamed
- Early return to full activity
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S&S
- Local pain and tenderness over Fx site - Horizontal orientation
- Gradual onset of pain (often exercise not redused)
- Initially, pain during activity, reduced when stopped
- Pain increases during activity, more deep+constant, eventually at rest and at night
- Pain increased w/ weight bearing (downhill run, deccelaration)
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H
- Nature and behavior of pain
- Changes in exercise, shoes, other physical stress activities
- Health, diet, menstruation
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O
- Local swelling
- Erythema, foot biomechanics, lower leg, knee
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P
- Tenderness (often severe) on deep pressure to bony surface a couple cm both above and below site
- No pain a few cm away
- Pain on superficial/moderate pressure on site of suspected Fx
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M
No change, unless swelling or pain interferes
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R
Maybe as bone Fx, sclerotomic
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S
- Snap test - snap DIST+PROX (or tuning fork)
- + (suspicion) = deep sclerotomic Pain
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Tx Goals
- pt edu (lay off it, shoes, biomechanics)
- Decr inflammation (shunt)
- Prevent adhesions (stretch)
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Hydro
- Acute
- Ice to CBAN for inflammation
- Sub-Acute
- Contrasts
- Chronic
- DMH, parafin waxx
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RemEx
- Acute
- Cycle w/o pain
- Sub-Acute
- Cross training
- Chronic
- Stretching, Cross training
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